Fetal reduction - twins to singleton

[mostlyhappy2010]

Hello,
I know that this may seem offensive to some, and I apologise in advance for this: I am desperate for some advice: I am 7 weeks pregnant with twins (non-identical). After 2 weeks on an emotional rollercoaster, I have decided that I cannot cope with twins due to health, emotional, practical, financial reasons. I am considering fetal reduction.
There seems to be very little information about fetal reduction from twins to a singleton. The doctors seem to default to termination of both. Has anyone got experience with fetal reduction in the UK? Where do I go for more information, either NHS or private?
Any information would be very useful. Thanks a million!

(Please do not post judgement: it has been a difficult decision, and it still is a difficult time).

wannaBe - It patently is possible to choose to a certain extent what type of pregnancy you have. Medical science gives us much more control than we used to have and this discussion wouldn't even be happening if it wasn't possible. What you are saying is that you don't think people should be able to choose in this situation.

To dismiss comparisons with single pregnancy choice as ridiculous does nothing to show how it is ridiculous. I think they are similar though there are differences. To me the ethical difference is to do with the sense of choosing between the two fetuses. The way reduction is carried out means that the mother would rarely be doing that. The consultant chooses based on their opinion of what will most likely bring about a safe outcome for the rest of the pregnancy. This is similar ethically to the way fertilized eggs are chosen for implanting in IVF - i.e. the ones that are most likely to lead to a successful pregnancy.

but the difference is that the fertilised egg is not a baby - it is a mere couple of cells. Even if the fertilised egg is replaced in the uterus there is still only a 30% chance that it will implant and then go on to become a pregnancy.

This is not a question of whether a woman who has two embrios should choose to only have one put back in case both should implant and lead to a twin pregnancy - this is a situation where a woman already has a twin pregnancy and has decided that one of the babies needs to be disposed of in order that she have the family she wanted. And the clear issue here is that this pregnancy was planned - terminating one twin is no less selfish than terminating a boy or a girl.

Just because medical science can do certain things doesn't mean that it should.

It is already possible to do gender selection through IVF, in time it would be possible to determine whether you have a brown eyed, dark haired child or a blue eyed, blonde one - should we condone this level of lifestyle choice just because medical science says it can be done?

'The consultant chooses based on their opinion of what will most likely bring about a safe outcome for the rest of the pregnancy. This is similar ethically to the way fertilized eggs are chosen for implanting in IVF - i.e. the ones that are most likely to lead to a successful pregnancy.'

How can that be certain in a twin pregnancy? I can see where it would be in a more multiple birth, particularly in your case after amnios it's well into the second trimester. And even in the case of embryo-analysis, particularly in the US where pre-genetic screening of embryos is more widespread and legal.

At any rate, the OP would need to go private, CVS is usually only offered on the NHS where there is a history of or family history of inherited disorders or there is an increased risk of abnormalities detected by scan or bloods, not because you'd rather have one rather than two.

I can imagine teh same might be true of selective reduction of a twin pregnancy which appears to be healthy and normal, hence, why when the OP saw her GP and others they would only discuss termination of both foetuses.

'It is already possible to do gender selection through IVF,'

Although at present this is not legal in the UK excepting in those who carry gender-linked genetic disorders; not for purposes of 'family balancing'.

In the US, though, wannabe, it's really a case of buying what you want in many instances.

I don't agree with Wannabe!

That's just setting the 'acceptable' threshold for termination where YOU would set it.

People have terminations all the time for their own strongly felt feelings at the time. I have had 2 terminations in circumstances where continuing the pg was a terrible thought for me. I have also been asked to consider the possibility of termination of a pg when losing the pg was the most terrible thought for me. (when it was suggested that ds may have trisomies not compatible with life). At that stage I would not have terminated for any disability - at other times in my life I terminated because I didn't want a child, any child. Had I been pg with 6, 7 or 8 embryos I would (I think, in as far as I can say not having been in that situation) have had selective reduction, and damn right, it would have been a 'lifestyle' choice! It's purely personal where you set your own threshold of 'selfish' and not particularly rational in comparison with other reasons for termination.

OP really sorry you are in the thick of a v difficult thought process. I have no experience of your situation at all, but it may be that Drs are reluctant to do a 2 to 1 reduction because the risks to the remanining foetus are so high compared to the risks of a twin pg generally. Wereas in a triplet or more pg the risks to all the foetuses are higher so the relative risk of reduction is lower, iyswim.

But I don't know.

Asking through Prof Nicolaides clinic might be a start.

oh yes, should have added in that it's not legal in the UK for family "balancing" purposes.

wannaBe - At 12 weeks it isn't a baby either, it's a fetus. You seem to think it is OK to have an abortion if you had sex but don't want a child, but not to have a reduction if you had sex but don't want two children. I just don't see the distinction between the two situations that you seem to and your reasoning is unclear to me - it seems contradictory given your position on abortion for an unwanted pregnancy, but I'm assuming that's because I don't understand what it is that is actually bothering you about it.

As to choosing or aborting on the basis of sex, eye, colour and other characteristics - Where it leads to a genetic imbalance in the population there are strong public health reasons for opposing it. I wouldn't do it and I find the idea distasteful. But I am loathe to judge it too harshly because there are ways in which it is similar, ethically, to choosing abortion because a child is likely to be born with severe disabilities. Obviously the outcomes are significantly differently but you are still basically saying one type of child is OK and another isn't.

Expat - How can they be certain? They can't be certain, it's a professional judgement based on many factors. Probably one of the reasons experience is one of the biggest indicators for the "safety" of the procedure. The amnios weren't about choosing the most likely candidate in terms of a successful procedure, it was more that if one was going to have a reduction based on amnio results then best to do that first and not destroy one fetus then have to do another because of amnio results. In my case I had other complications than just the fact it was a triplet pregnancy, and one fetus was a significant risk to the pregnancy anyway, but in discussions before hand the consultant mentioned a number of things he looked at. I recall position was one of them, I think size and/or vitality of the fetus and the security of the attachment to the womb, there were others as well but I wasn't taking notes.

I'd also point out that in my experience selection on physical characteristics like sex were not easily available in the states. Though it's not illegal and it does happen. The consultants I talked to would not give information on sex of the fetus before the reduction had taken place (I asked, not because I wanted to select on that but because I was dying to know).

Mine was a baby from the minute I got the positive pregnancy test. I don't care what anyone else says it was. My baby, my opinion.

FAB5 That's great for you. But irrelevant to the issue that was being discussed. For some people it's a baby from the moment of fertilization. For others it's a baby only once it's born. Putting your own definition on the stages in general in order to align more closely with one end of a spectrum is arbitrary without further justification.

and just like it would be wrong of anyone to suggest otherwise, FAB, with regards to your baby, so it is wrong for anyone to suggest that someone else should feel the same!

xpost with YourChoice. who says it much better than me.

Where did I say that anyone else should feel the way I did?

you're right, you didn't. I was projecting what I thought you were saying, rather than reading your words at face value. sorry.

Thank you. It's fine .

As a twin myself I really urge you to think of the impact on the single baby you are left with. My sister died at 11 weeks old and my parents have always been open about that. Is it something you would keep from the child as he/she grows up? I'm not judging, just wonder if you've given this any thought as you and dh/dp will need to agree on things like this.

Most of what I've read is supportive so I hope you don't feel you are being attacked. I had a termination at 19 so I cannot judge but I would say it has taken a long time to get over and knowing what I know now makes it harder - dh was the father but was only a boyfriend back then. Our decision was based on the fact our relationship was too new and financially we were in no position to have a baby.

I now have a beautiful dd and am pg with twins (big shock but we are delighted). We have no idea how we will cope financially. dd didn't sleep at all so we figure dts cannot sleep less than her. We've also gone very chilled out about it all and just say it was clearly meant to be and we have a good relationship so we know we will be fine. I like to plan everything but it seems that has been taken away so I've just gone with it - it works for us. As soon as dd was born I regreted my previous termination. Who was I to take this life. But I understand it's not the same for everybody and I am sure you've not made this decision lightly. I'm just trying to say, make sure that if you do go ahead, you get lots of emotional support.

Hi Mostlyhappy,
I really wanted to make contact with you on this thread, although it seems to have run off without you somewhat! I hope you're still following posts, although I understand that with the timescale that's passed, you may have made all the decisions you've had to and be at a different point in your pregnancy.
I'm 12 weeks pregnant with my first pregnancy tachieved through IUI.
I've been trying for a baby with my partner of 9 years for several years and was offered ART treatment about 5 years ago, but it's taken me a while to keep trying and realise my chances of pregnancy unassisted are very slim. I have polycystic ovaries which drastically affects my menstrual cylcle, so I just don't ovulate unassisted, except for maybe once every 7 years or so.
At my 6week scan, we found that I'm carrying triplets, which has taken a long time to sink in, and we feel we have to consider fetal reduction.
It's a subject that is not addressed much; there's absolutely nothing on the NHS website relating to it and I've seen very few references on UK websites at all.
Obviously it's a fraught, contentious issue, you and I know that probably more than most of the other people posting on this thread, and really not something I think about lightly.
My concern is about the best outcomes for my babies, and to me, I'm not sure that being 2 months premature and incubated is the best thing for my children, along with the other potential risks.
Having been forced to make such proactive choices to achieve this pregnancy, which believe me, I have wanted for a long time and am ultimately grateful for, My personal feeling is that I cannot simply leave it up to nature at this point, having put my future children in a risky position that would not have been likely had i concieved naturally. My consideration is about taking responsibilty.
I know many people manage just fine with multiples and that premature babies survive and can lead healthy, happy lives.
Obviously it's hard for somebody with healthy childtren, or who are coping fine with multiples, or children with disabilities to sympathise with someone considering fetal reduction, but it is about knowing your own situation, financially, in terms of support and the reality of your own life; making your own choices about parenting and taking responsibility for them.
I know that fetal reduction can increase the likelihood of miscarriage by 5-10%. There's very little candid advice and all the medical professionals I've tried to discuss this with have been massively cautious about advising me, so concerned are they not to sway a decision either way, so it's an incredibly lonely, frightening thing to consider, especially when you want your pregnancy and have had to fight for it. I just want the best possible poutcome for my pregnancy and my children, and that might not be keeping all three.

Best of luck x

I am shocked and saddened to read this thread. Firstly because this is the first time I've heard of 'fetal reduction'.

I am a mother of 14 month old identical twin boys. Year one was tough (also have a 3 year old DD) but I can't imagine life without them (as of couorse other twin mum posters have said here).

My point is simply this: If you have decided to have children (I mean deliberately) you should also decide to cope with whatever child/children you are given. Of course we have control over our fertility but we shouldn't really decide on the kind of child we'll have. Having children is a bit of a leap of faith.

Don't wish to sound preachy, good luck op with whatever you decide.

Hello, i just wrote to search: twins and i got a page and i see your message. I did not know about the fetal reduction.
I have a twin girls, they are two month old. We have got a help from the Home Start, because they are our first babies and the babies do not have a grandma or grandpa, who can help us. So i do not say that everything is easy, but i love my babies and i think if you have got this wonder do not drop. I can not to imagine my life without them or without one of them, they are the best thing in my life!
When i gave a birth few days just came the tear from my eyes, i did not cry, i was so happy!
It is your life, and i know, not easy, but if you decide that you give a birth your twins, i wish you the best! Healthy, happiness! X
Oh, i am sorry, i am not english, but i hope you will understand me! If no, just ask!
Have a nice day!

For the financial reasons: i came from another country, but here we have got the all help what just possible. We have got for example from the Sure Start Childrens Centre baby clothes, buggy... From the Home Start come to us a mum for free twice a week to help! She look after for the babies, she help to bath them, we go for a walk, she help what just i need.
I worried about the birth, but my babies birth within 1,5 hours with gas and air painrelief without any problem. When i came home my weight was the same like before pregnancy. My babies and me are healthy.

Please bear in mind that this thread was started in April 2011

Hello. Even though this is a very old thread, we're going to move it to Antenatal tests and choices - where it really belongs.

i have a 3year daughter now pregnant this time with twins,which became a nightmare for me..i havent slept for 2 days..i m freaking out..we foundout this on 12 week ultrasound...now we r considering selective reduction to one baby..

Anybody did selective reduction ? will the other baby be healthy?Is it insurance covered,otherwise how much does it costs?

I m so miserable,my husband is the only support even if he is more sad.

i had a laproscopic surgery for 2hernias& to remove gallbladder 2years before,it was caused by first pregnancy..didnt get rest after c-section no help was here except my husband who works over the clock...i cannot work here cos of my immigration status.

this time i dont think there is space in my stomach,twins can be prematture ,financially also we will broke with 3kids i am so mentally and physically too tired of this pregnancy .

I am pro-choice, and I believe that you are not doing anything morally 'wrong' by reducing a twin pregnancy. But I do want to give you my perspective in case it helps. I had two young children and was 41 when I found out I was pg with id twins. My dp and I were not getting on. One of the twins was not growing properly and could have ended up with problems, or caused both to be delivered very premature. We have a small house. I suffer from anxiety quite badly. I considered fetal reduction. I - and my dp - are SO SO glad I didn't do it. The twins are now 1 and they are the utter light of my life. I am so excited to watch their twin relationship developing. I don't know how/what I would have told the other one if I had terminated one. They are hard work but hard work is just hard work - it's not the end of the world.
This is totally not meant to be judgemental - how could it be, when I considered reduction myself? It is you who is pg and you who will be bringing them up. It's your decision and people should not judge. But I just wanted to share with you how happy and relieved I am at the decision I made.
Best of luck.